Long-Term Outcomes of Renal Transplant Allografts With De Novo DSA in the Setting of Stable Function.

BACKGROUND: We sought to determine the long-term outcomes of renal allografts that developed de novo DSA (dnDSA) in the setting of stable function.

METHODS: This retrospective single-center review of renal allograft recipients transplanted between January 2008 and December 2011. DnDSA testing was performed at 3, 6, 9, and 12 months and yearly thereafter.

RESULTS: The study included 501 recipients; 84% primary transplants, and 37% living donors. The median follow-up duration was 110 (range 9-157) months. One hundred fifty-seven (31%) recipients developed dnDSA, and the median time to the first dnDSA was 18 (range 3-144) months. Death-censured graft survival in recipients with no DSA was significantly better than that of dnDSA-positive recipients. There were 344 recipients with no DSA (group 1), 117 recipients with dnDSA and stable graft function (group 2), and 40 recipients with dnDSA-associated acute rejection (group 3). Death-censured graft survival was equivalent between groups 1 and 2 and significantly better than that in group 3. Seventy-eight percent of Group 3 lost their grafts at a median of 56 (range 12-137) months posttransplant. Group 2 recipients had an increased incidence of late acute rejection compared to group 1 (p < 0.001), yet the mean eGFR values of both groups were equivalent at one, 5, and, 10 years posttransplantation (p > 0.05).

CONCLUSIONS: Development of dnDSA in recipients with stable graft function increased the risk of late acute rejection, but had no detrimental impact on long-term graft survival or function. De novo DSA, associated with acute rejection, generally resulted in long-term graft loss.